The development of ethical guidelines and regulations regarding human subjects research has focused upon protection of vulnerable populations by relying on a categorical approach to vulnerability. This results in several challenges: First, Institutional Review Boards (IRBs) struggle to interpret and apply the regulations because they are often vague and inconsistent. Second, applying the regulations to subjects who fit within multiple categories of vulnerability can lead to contradictions and the rejection of research that would be permissible if only one category were applicable...

This paper proposes a victim-centered account of microaggressions within the context of clinical medicine. In so doing, it argues that microaggressions can undermine physician-patient relationships, preclude relationships of trust, and therefore compromise the kind and quality of care that patients deserve. Ultimately, by focusing on the experiences of victims of microaggressions, the paper demonstrates how harmful microaggressions in clinical medical contexts can be, and thus provides strong reasons why healthcare providers ought to know about them and actively work to avoid committing them...

In this investigation, I focus on individual memory behaviors for which we commonly blame and praise each other. Alas, we too often do so unreflectively. Blame and praise should not be undertaken lightly or without a good grasp on both what we are holding people responsible for, and the conditions under which they can be held responsible. I lay out the constructivist view of memory with consideration for both remembering and forgetting, and special attention to how we remember events as well as whether we remember them...

Dominant views about the nature of health and disease in bioethics and the philosophy of medicine have presumed the existence of a fixed, stable, individual organism as the bearer of health and disease states, and as such, the appropriate target of medical therapy and ethical concern. However, recent developments in microbial biology, neuroscience, the philosophy of cognitive science, and social and personality psychology have produced a novel understanding of the individual and its fluid boundaries. Drawing on converging evidence from these disciplines, and following recent research in public health, we argue that certain features of our biological and social environment can be so tightly integrated as to constitute a unit of care extending beyond the intuitive boundaries of skin and skull...

Programs of drug testing welfare recipients are increasingly common in US states and have been considered elsewhere. Though often intensely debated, such programs are complicated to evaluate because their aims are ambiguous-aims like saving money may be in tension with aims like referring people to treatment. We assess such programs using a proportionality approach, which requires that for ethical acceptability a practice must be reasonably likely to meet its aims, sufficiently important in purpose as to outweigh harms incurred, and lower in costs than feasible alternatives...

This paper advances a novel conception of the child's best interest in regard to pediatric surgeries that do not promote the preventive or therapeutic health needs of children, namely elective pediatric surgeries (EPS). First, children's capacity for decision making is examined, and the best decision-making model for EPS is identified as the Best Interest Standard. What follows is a discussion of the interests of children in the context of EPS, the correlation of fundamental interests to rights, and guidelines for weighing children's competing interests...

The goal of this paper is to problematize the use of sex categories in medical contexts. We question the benefits of categorizing all individuals as either male or female in medical contexts and argue that we should focus instead on the relevant sex-related properties of patients. Contrary to what many people believe, the classificatory system by which sexed bodies are neatly divided into male and female is anything but clear. An abundance of evidence shows that a binary sex system does not accurately describe the reality of human bodies...

Too often the idea of young Black boys as sexually aggressive or criminally assaultive displaces the idea that they can be victims at all. As such, Black boys are not theorized or researched as victims of sexual violations in current gender literatures. Instead they are almost exclusively represented as perpetrators of sexual violence, not victims of it. This study examines five snapshots of Black men who were victims of sexual violations as young boys. Our findings indicate that Black males are uniquely at risk for sexual impropriety and statutory rape, primarily via older women and teenage girl female-perpetrators (although risk also includes same-sex violations)...

Autonomy plays a central role in bioethics, but there is no consensus as to how we should understand this concept. This paper critically considers three different conceptions of autonomy: the default conception prevalent in bioethics literature; a broader procedural account of autonomy drawing on moral philosophical approaches; and a substantive, perfectionist account. Building on Rebecca Walker's critique of the default conception of autonomy, we will argue that a substantive, perfectionist approach both fulfils Walker's criteria for a conception of autonomy in bioethics and lends itself to application in practical scenarios...

Discussion of reparations for U.S.-Guatemala STD experiments of the 1940s and 50s should be informed by a range of international and U.S. reparation experiences, so that features that impair the effectiveness of repair are avoided, and features that enhance effectiveness of repair are emulated. Two features have contributed to the effectiveness or ineffectiveness of repair elsewhere but have not been critically examined in relation to the Guatemalan experiments: Whether experimental subjects or their families have the opportunity to participate in reparations processes, and whether any group of experimental subjects is intentionally denied recognition...

Sponsorship bias occurs when the financial interests of funders of scientific research influence claims made by scientists, especially in peer-reviewed publications. This article examines the relationship between sponsorship bias and misleading claims, understood as claims that are not necessarily false but which encourage those exposed to them to infer false conclusions. Misleading claims are relevant to how the term "bias" should be understood and thereby to evaluating a recent dispute about whether there is evidence of sponsorship bias in clinical research on statins...

The SUPPORT trial highlights ethical challenges raised by comparative effectiveness randomized controlled trials (ceRCTs) involving one or more usual care interventions. Debate about the SUPPORT trial has focused on whether study interventions posed "reasonably foreseeable risks" to enrolled infants and, thereby, reflects a preoccupation with U.S. regulations. As ceRCTs are conducted globally, our analysis of the SUPPORT trial is grounded in internationally accepted ethical principles. We argue that the central ethical issue raised by the SUPPORT trial is the following: should the SUPPORT trial interventions be conceptualized as practice, or research? The answer to this question has important implications for "downstream" ethical requirements-including whether the usual care interventions in ceRCTs require research ethics committee review, undergo harm-benefit analysis, and are included in informed consent documents-and it is antecedent to the development of ethical guidance for ceRCTs...

Hospitalized older patients are more vulnerable to physical or cognitive functional decline. Inpatient rehabilitation programs improve significantly their functional status and may prevent their admission to nursing homes. While inpatient rehabilitation institutions have established admission criteria that can be seen as objective, the risk of bias remains and raises the question of equitable access for more vulnerable populations such as older patients. This paper reviews some established eligibility criteria for inpatient rehabilitation by examining a framework used in Montreal, Québec, Canada for assessing rehabilitation eligibility and by applying this framework to a case study...

This paper demonstrates that acceptance of voluntary euthanasia does not generate commitment to either non-voluntary euthanasia or euthanasia on request. This is accomplished through analysis of John Keown's and David Jones's slippery slope arguments, and rejection of their view that voluntary euthanasia requires physicians to judge patients as better off dead. Instead, voluntary euthanasia merely requires physicians to judge patients as within boundaries of appropriate deference. This paper develops two ways of understanding and defending voluntary euthanasia on this model, one focused on the independent value of patients' autonomy and the other on the evidence of well-being provided by patients' requests...

Research on the genomic correlates to addiction raises ethical issues in a number of different domains. In this paper, we evaluate the status of genetic research on alcohol dependence as background to addressing the ethical issues raised in conducting research on addiction and the application of that research to the formulation of public policies. We conclude that genetic testing is not yet ready for use in the prediction of alcohol dependence liability. Pharmacogenetic testing for responses to treatments may have more clinical utility, although additional research is required to demonstrate utility and cost-effectiveness...

While citizens in a liberal democracy are generally expected to see to their basic needs out of their own income shares, health care is treated differently. Most rich liberal democracies provide their citizens with health care or health care insurance in kind. Is this "special" treatment justified? The predominant liberal account of justice in health care holds that the moral importance of health justifies treating health care as special in this way. I reject this approach and offer an alternative account...